Objective: To investigate the long-term prognosis of Second generation drug-eluting stents(G2-DES) in diabetic mellitus(DM) and non-DM patients. Methods: Patients with coronary heart disease(CHD) in Fuwai Hospital from January 2013 to December 2013 who had exclusively G2-DES implantation, were consecutively included the follow-up period was 2 years. Results: A total of 6 094 patients with CHD were implanted with G2-DES, of which 1 862 patients with DM, and 4 232 patients without DM.The proportion of DM patients receiving G2-DES implantation with the following characteristics: advanced age, female, hypertension, hyperlipidemia, history of previous stroke, history of peripheral artery disease, previous history of PCI, and with triple vessel, high preoperative Syntax score, high number of target lesions, B2 or C type lesions, severe calcification lesions, and chronic occlusive disease were significantly higher than those of non-DM patients(P<0.05). The incidence of major adverse cardiac and cerebral vascular events(MACCE), target vascular revascularization(TVR) and target lesion revascularization(TLR) were higher in DM patients than in non-DM patients during 2 year's follow-up(P<0.05). The univariate COX regression analysis showed that diabetes was risk factor for MACCE in patients with CHD implanting G2-DES(HR=1.241, 95%CI: 1.053-1.463, P=0.010). However, multivariable COX analysis showed that DM was not an independent risk factor for MACCE in CHD patients with G2-DES(HR=1.125, 95%CI: 0.952-1.330, P=0.167). While age, female, preoperative Syntex score, triple vessel, B2 or C lesion were independent risk factors for poor clinical prognosis in CHD patients with G2-DES. Conclusions: (1) CHD patients with DM often accompany more clinical risk factors and complicated coronary lesions; (2) the incidence of MACCE, TVR and TLR in DM patients is significantly higher than non-DM patients with G2-DES during the 2 year's follow-up; (3) after multivariate adjustment, DM is not an independent risk factor for poor clinical prognosis in CHD patients with G2-DES, while traditional risk factors and complex coronary lesions are independent risk factors for poor clinical prognosis.
目的： 探讨糖尿病与非糖尿病患者置入第二代药物洗脱支架(DES)的远期预后。 方法： 连续纳入阜外医院2013年1—12月置入第二代DES的冠心病患者，PCI术后随访2年，比较随访期间糖尿病与非糖尿病患者的远期预后。 结果： 共有6 094例患者置入第二代DES，其中糖尿病患者1 862例，非糖尿病患者4 232例。置入第二代DES的糖尿病患者临床特点(高龄、女性、高血压、高脂血症、既往脑卒中病史、外周动脉疾病史、既往PCI病史等)以及冠状动脉病变情况(三支病变、术前Syntax评分、靶病变个数、B2或C型病变、严重钙化病变以及慢性闭塞病变等)的比例均明显高于非糖尿病患者(P<0.05)。2年随访结果显示，置入第二代DES的糖尿病患者，主要不良心脑血管事件、靶血管及靶病变血运重建的发生率均较非糖尿病患者高(P<0.05)。单因素COX回归分析显示，糖尿病是置入第二代DES冠心病患者主要不良心脑血管事件的独立危险因素(HR＝1.241, 95%CI 1.053～1.463, P＝0.010)。多因素COX分析显示：糖尿病并不是置入第二代DES冠心病患者主要不良心脑血管事件的独立危险因素(HR＝1.125, 95%CI 0.952～1.330, P＝0.167)。高龄、女性、术前Syntax评分、三支病变、B2或C型病变是置入第二代DES冠心病患者不良临床预后的独立危险因素。 结论： (1)置入第二代DES冠心病合并糖尿病患者常伴随更多临床高危因素和复杂冠状动脉病变；(2)置入第二代DES的糖尿病患者主要不良心脑血管事件、靶血管血运重建和靶病变血运重建的发生率明显高于非糖尿病患者；(3)经校正多种危险因素后，糖尿病并不是置入第二代DES冠心病患者不良临床预后的独立危险因素；而传统的临床高危因素及复杂高危的冠脉病变则是不良临床预后的独立危险因素。.
Keywords: Coronary heart disease; Diabetes mellitus; Second generation drug eluting stents.